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Objective: Dimension-specific objective measures are criticized for their limited perspective and failure to endorse subjective perceptions by respondents, but the validity and correlates of a subjective global measure of successful aging (SA) are still not well established. We evaluated the reliability and validity of a self-rated analogue scale of global SA in an elderly Singaporean population. Design: Cross-sectional data analysis using a comprehensive questionnaire survey. Participants and setting: 489 community-dwelling Singaporeans aged 65 years and over. Measurements: Self-rated SA on an analogue scale from 1 (least successful) to 10 (most successful) was analyzed for its relationship to criterion-based measures of five specific dimensions (physical health and function, mental well-being, social engagement, psychological well-being, and spirituality/religiosity), as well as outcome measures (life satisfaction and quality of life). Results: Self-rated SA was significantly correlated to measures of specific dimensions (standardized β from 0.11 to 0.39), most strongly with psychological functioning (β = 0.391). The five dimension-specific measures together accounted for 16.7% of the variance in self-rated SA. Self-rated SA best predicted life satisfaction (R2 = 0.26) more than any dimension-specific measure (R2 from 0.05 to 0.17). Self-rated SA, vis-à-vis dimension-specific measures, was related to a different set of correlates, and was notably independent of chronological age, sex, education, socioeconomic status, and medical comorbidity, but was significantly related to ethnicity. Conclusion: The self-rated analogue scale is a sensitive global measure of SA encompassing a spectrum of underlying dimensions and subjective perspectives and its validity is well supported in this study. © 2014 American Association for Geriatric Psychiatry.

Background: This study examined the use of low doses of antipsychotic medications (300 mg/day CPZeq or less) in older Asian patients with schizophrenia and its demographic and clinical correlates.Methods: Information on hospitalized patients with schizophrenia, aged 55 years or older, was extracted from the database of the Research on Asian Psychotropic Prescription Patterns (REAP) study (2001-2009). Data on 1,452 patients in eight Asian countries and territories including China, Hong Kong, Japan, Korea, Singapore, Taiwan, India, and Malaysia were analyzed. Sociodemographic and clinical characteristics and antipsychotic prescriptions were recorded using a standardized protocol and data collection procedure.Results: The prescription frequency for low doses of antipsychotic medications was 40.9% in the pooled sample. Multiple logistic regression analysis of the whole sample showed that patients on low doses of antipsychotic medications were more likely to be female, have an older age, a shorter length of illness, and less positive symptoms. Of patients in the six countries and territories that participated in all the surveys between 2001 and 2009, those in Japan were less likely to receive low doses of antipsychotics.Conclusion: Low doses of antipsychotic medications were only applied in less than half of older Asian patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Background: The precise relationship between depression and cognitive decline in older adults is unclear. We investigated the influence of apolipoprotein E (APOE)-epsilon4 genotype in modulating the effect of depressive symptoms on cognitive decline.Methods: Prospective cohort study of 1,487 cognitively high-functioning Chinese older adults. Depressive symptoms (Geriatric Depression Scale score >/=5) and Mini-Mental State Examination (MMSE) were assessed at baseline, and cognitive decline (at least 1-point drop in MMSE) at 1-2 years after baseline.Results: There was no significant difference in cognitive decline between depressed (32.9%) and nondepressed (31.5%) participants in the whole sample or among non-APOE-epsilon4 carriers. Among APOE-epsilon4 carriers, depressed participants showed more cognitive decline (40.0%) than their nondepressed counterparts (28.6%), odds ratio = 2.89, 95% confidence interval: 1.03-8.12; p = .04, after controlling for age, gender, education, vascular risk factors/events, smoking, alcohol drinking, physical functioning, subjective memory complaint, length of follow-up, and baseline MMSE scores (p for interaction = .03).Conclusions: Our study suggests that the presence of the APOE-epsilon4 allele significantly enhanced the risk of cognitive decline associated with depressive symptoms. This finding should be independently replicated in future studies. [ABSTRACT FROM AUTHOR]

BACKGROUND: Laboratory research suggests that tea has potential neurocognitive protective effects, but this is not established in humans. OBJECTIVE: We aimed to examine the relation between tea intake and cognitive impairment and decline. DESIGN: Among community-living Chinese adults aged > or = 55 y in the Singapore Longitudinal Ageing Studies cohort, we measured tea consumption at baseline and administered the Mini-Mental State Examination (MMSE) at baseline and 1-2 y later. Cognitive impairment was defined as an MMSE score < or = 23 and cognitive decline as a drop in MMSE score of > or = 1 point. We performed cross-sectional analysis of baseline data from 2501 participants and longitudinal analysis of data from 1438 cognitively intact participants. Odds ratios (ORs) of association were calculated in logistic regression models that adjusted for potential confounders. RESULTS: Total tea intake was significantly associated with a lower prevalence of cognitive impairment, independent of other risk factors. Compared with the ORs for rare or no tea intake, the ORs for low, medium, and high levels of tea intake were 0.56 (95% CI: 0.40, 0.78), 0.45 (95% CI: 0.27, 0.72), and 0.37 (95% CI: 0.14, 0.98), respectively (P for trend < 0.001). For cognitive decline, the corresponding ORs were 0.74 (95% CI: 0.54, 1.00), 0.78 (95% CI: 0.55, 1.11), and 0.57 (95% CI: 0.32, 1.03), respectively (P for trend = 0.042). These effects were most evident for black (fermented) and oolong (semi-fermented) teas, the predominant types consumed by this population. In contrast, no association between coffee intake and cognitive status was found. CONCLUSION: Regular tea consumption was associated with lower risks of cognitive impairment and decline. Copyright © 2008 American Society for Nutrition [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the association of the metabolic syndrome (MS) with cognitive decline in a Chinese older population. METHODS: In a prospective cohort study of 1,352 community-living Chinese older adults without cognitive impairment (Mini Mental State Examination, MMSE <24) and without cardiovascular disease and stroke, the authors assessed baseline MS (defined according to International Diabetic Federation Criteria). Cognitive decline was predefined as at least 2-point drop in MMSE score at follow-up 1-2 years after baseline assessment. RESULTS: MS was present in 26.3% of the participants at baseline and was significantly associated with the risk of cognitive decline (odds ratio, 1.42: confidence interval, 1.01-1.98), after controlling for potential confounding by age, gender, education, smoking, alcohol drinking, depressive symptoms, APOE-e4 status, level of leisure activities, baseline MMSE, and length of follow-up. CONCLUSION: The MS was associated with increased risk of cognitive decline in Chinese older adults. [ABSTRACT FROM AUTHOR]

BACKGROUND: Studies that investigated the relationship between obesity and depressive symptoms in the elderly have generated conflicting findings, partly because of the use of body mass index (BMI) alone to measure obesity in the elderly. The use of BMI fails to account for varying proportions of muscle, fat and bone, and few studies have used other measures of central obesity, such as waist-hip ratio (WHR) and waist circumference (WC). OBJECTIVES: We examined whether individually BMI, WHR and WC were consistently associated with depressive symptoms in the elderly. METHODS: Analysis of cross-sectional data of 2604 community dwelling Chinese elderly aged 55 and above, including socio-emotional characteristics, self-rated health and functional status, anthropometric measurements and Geriatric Depression Scale (15 items, GDS-15). RESULTS: There was a negative trend in the prevalence of depressive symptoms (GDS >/=5) across increasing BMI categories: 16.9% in low BMI, 14.2% in normal weight, 12.1% in moderate to high BMI. The associations for moderate to high BMI (OR, 0.77; p = 0.04) relative to normal BMI, were statistically significant after controlling for confounding variables. However, no consistent trends in the prevalence of depressive symptoms and OR's were observed for increasing WHR and WC categories. CONCLUSION: Our results suggest that waist-hip and circumference measures of central obesity did not support an inverse relationship of obesity and depressive symptoms. An inverse relationship of BMI with depressive symptoms may indicate greater physiologic and functional reserve from greater muscle mass that protects against depressive symptoms. Copyright (c) 2007 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Few studies have investigated the association of psychiatric morbidity with acute hospitalization risk in elderly people.Method: We examined this association using population-based data for 1092 older adults aged > or =60 years in Singapore, including subjects who reported at least one acute hospitalization from any medical condition(s) in the 12 months prior to interview (N = 136). Psychiatric morbid/comorbid disorders were diagnosed using the Geriatric Mental State examination.Results: In a multivariate analysis, comorbid psychiatric disorders were independently associated with hospitalization [adjusted odds ratio 2.76, 95% confidence interval 1.20-6.33], after controlling for age, ethnicity, employment status, number of medical comorbidities, number of activities of daily living limitations, hearing and visual impairment, SF-12 Physical and Mental Component Summary scores, social, productive, fitness and health activities, and regular visits to health-care providers. Neither dementia diagnosis nor cognitive impairment measured by the Mini-mental State Examination was associated with increased hospitalization risk.Conclusion: Psychiatric morbidity in old age was significantly associated with increased hospitalization risk. This finding underlines the importance of treating psychiatric illness to reduce the risk of acute hospitalization in elderly patients. [ABSTRACT FROM AUTHOR]

Background: We sought to assess the validity of the physical and cognitive domains of Lawton and Brody's Instrumental Activities of Daily Living (IADL) scale and its cross-cultural applicability across ethnic groups in an Asian population of community-living older adults.Methods: Using data from a random population sample of noninstitutionalized Chinese, Malay, and Indian older adults 60 years old and older in Singapore (N = 1072), we modeled the dimensional structure of the 8-item IADL Scale using exploratory and confirmatory factor analyses, and assessed its convergent and divergent validity using known group differences and strengths of association.Results: Factor analyses yielded two strong and reliable factors representing underlying physical and cognitive dimensions of IADL. The validity of the model was supported by the pattern of associations of the IADL with age, gender, education, self-reported health status, hospitalization, physical comorbidities, dementia and depression, and Mini-Mental State Examination (MMSE) scores. Notably, cognitive IADL showed a greater total effect on MMSE cognitive performance score than did physical IADL, with the effect of physical IADL on MMSE score mostly explained by cognitive IADL. Reasonably good cross-cultural validity was demonstrated among Chinese, Malays, and Indians, with strongest validity for Indians.Conclusion: The eight-item IADL Scale has physical and cognitive domains and is cross-culturally applicable. The cognitive IADL domain taps a set of activities directly related to cognitive functioning. [ABSTRACT FROM AUTHOR]

BACKGROUND/AIMS: Recent research has attempted combinations of instruments to improve screening accuracy for mild cognitive impairment (MCI) and early Alzheimer's disease (AD). We compared Mini-Mental State Examination (MMSE), Immediate and Delayed Recall (Logical Memory I and II; LM-I and LM-II, respectively), a single-item informant report of memory problem (IRMP), and a four-item Instrumental Activities of Daily Living (4IADL) scale, and combinations of these tests. METHOD: The tests were administered together with Clinical Dementia Rating (CDR) to subjects who were cognitively intact (CDR = 0, n = 88), and with diagnoses of MCI (CDR = 0.5, n = 37) and early AD (CDR = 1-2, n = 19). RESULTS: Screening accuracy (receiver operating characteristic area under curve, AUC) for identifying MCI or MCI-AD was lowest for MMSE (AUC 67.6% for MCI or 77.9% for MCI-AD), and better for IRMP (79.5 or 83.2%), 4IADL (76.9 or 84.7%), LM-I (81.2 or 87.1%) and LM-II (86.1 or 90.8%). Combining IRMP, 4IADL and LM-II was most accurate (AUC 91.7% for MCI or 94.5% for MCI-AD); sensitivity: 86.5 or 89.3%; specificity: 86.4 or 88.6%. However, combining IRMP and 4IADL gave nearly as good accuracy (AUC 87.2 or 91.6%); sensitivity: 86.5 or 85.7%; specificity: 79.5 or 85.2%. CONCLUSION: A brief instrument combining an IRMP and 4IADL items is potentially useful in screening for MCI and early AD. [ABSTRACT FROM AUTHOR]

Objective: To ascertain the extent of the community's preference, needs for and utilization of mental health services, and their socio-demographic determinants in the multi-ethnic Asian community in Singapore. The extent to which need, enabling and predisposing factors determine the likelihood to seek professional help was also examined. Method: Data were analyzed from the Singapore National Mental Health Survey of 1996, based on a stratified random sample of 2947 Chinese, Malay and Indian subjects of the general population aged 13-64 years. Results: An estimated 37% of the general population indicated they would seek professional help if they experienced a serious emotional or mental problem. Although 16.9% were determined by their high general health questionnaire (GHQ) score to need mental health services, only 2.6% in the population used the services of any professional caregiver. Among persons with high GHQ scores, only 5.9% sought any professional help. Among those with a high GHQ score and who were receptive to professional help, only 10.4% actually sought professional help. General practitioners were the most commonly preferred caregiver (49.3%), and were used by 41.1% of those who sought help. Those who sought professional help were more likely to have a high GHQ score and to be inclined to seek professional help. Malays used mental health services more than Chinese, but they did not show a significantly greater prevalence of high GHQ scores, or a greater preference to seek professional help. Receptivity to professional help, high GHQ score, and Malay ethnicity were independent significant predictors of use of mental health service. Conclusion: Need and attitudinal factors predict mental health service utilization, but they still do not explain why a large majority of the population chose not to use mental health services. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to determine whether there is any temporal variation in the incidence of parasuicide within the Chinese community and, if possible, to correlate the findings with prevailing cultural and social influences. METHOD: All patients of Chinese origin referred to a teaching hospital in Singapore between 1990 and 1994 were included in the study. The cases were divided by sex and aggregated for the month and day of the week in which the parasuicides occurred. RESULTS: Cases of parasuicide peaked on Mondays, while the lowest incidences occurred on Saturdays. The peak months were June, August and September with a trough in December and January. CONCLUSIONS: The findings may not be amenable to any single explanation but the peak months coincided with the month of the Hungry Ghosts, which is believed to be a particularly inauspicious period, while the trough occurred during a festive period. Similarly, looking at the student population, the peaks coincided with the examination period. It appears that social and cultural factors play a significant role in the temporal variation in parasuicide in Singapore. [ABSTRACT FROM AUTHOR]

Background: Dementia, particularly Alzheimer's disease, is a major healthcare challenge in ageing societies., Objective: This study aimed to investigate the efficacy and safety of a dietary compound, ergothioneine, in delaying cognitive decline in older individuals., Methods: Nineteen subjects aged 60 or above with mild cognitive impairment were recruited for this double-blinded, randomized, and placebo-controlled study (ClinicalTrials.gov identifier: NCT03641404, registration date: 19/08/2018). Subjects received either ergothioneine (25 mg per capsule) or a placebo, taken 3 times a week for one year. The whole blood profile, markers of renal and liver functions, neurocognitive performance, plasma levels of ergothioneine and its metabolites, and plasma biomarkers related to neurodegeneration were measured across the study., Results: Ergothioneine intake did not alter clinical safety markers (blood counts, kidney and liver function) throughout the study, further validating its safety for human consumption. Subjects receiving ergothioneine demonstrated improved performance in assessment of learning ability and stabilized plasma levels of neurofilament light chain, compared with the placebo group, which saw no improvement in cognitive assessments and a significant increase in neurofilament light chain levels., Conclusions: Prolonged intake of ergothioneine showed no toxicity in elderly people. Enhanced Rey Auditory Verbal Learning Test performance and stabilized neurofilament light chain levels suggest improvements in memory and learning abilities and a deceleration of neuronal damage, respectively. Our results add to existing data that ergothioneine is safe for extended consumption and may hold the potential to delay cognitive decline in elderly adults., Competing Interests: Declaration of conflicting interestsL. Feng is an Editorial Board Member of this journal but was not involved in the peer-review process of this article nor had access to any information regarding its peer-review. The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Patients with Alzheimer's disease present with difficulty in lexical retrieval and reversal of the concreteness effect in nouns. Little is known about the phenomena before the onset of symptoms. We anticipate early linguistic signs in the speech of people who suffer from amnestic mild cognitive impairment (MCI). Here, we report the results of a corpus-linguistic approach to the early detection of cognitive impairment., Methods: One hundred forty-eight English-speaking Singaporeans provided natural speech data, on topics of their choice; 74 were diagnosed with single-domain MCI (38 amnestic, 36 non-amnestic), 74 cognitively healthy. The recordings yield 267,310 words, which are tagged for parts of speech. We calculate the per-minute word counts and concreteness scores of all tagged words, nouns, and verbs in the dataset., Results: Compared to controls, subjects with amnestic MCI produce fewer but more abstract nouns. Verbs are not affected., Discussion: Slower retrieval of nouns and the reversal of the concreteness effect in nouns are manifested in natural speech and can be detected early through corpus-based analysis., Highlights: Reversal of the concreteness effect is manifested in patients with Alzheimer's disease (AD) and semantic dementia.The paper reports a corpus-based analysis of natural speech by people with amnestic and non-amnestic mild cognitive impairment (MCI) and cognitively healthy controls.People with amnestic MCI produce fewer and more abstract nouns than people with non-amnestic MCI and healthy controls. Verbs appear to be unaffected.The imageability problem can be detected in natural everyday speech by people with amnestic MCI, which carries a higher risk of conversion to AD., Competing Interests: The authors declare no conflicts of interest. The research is approved by the institutional review board of the National University of Singapore (H‐17‐047). Author disclosures are available in the supporting information., (© 2024 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals LLC on behalf of Alzheimer's Association.)

Objectives: Mild Cognitive Impairment (MCI) is an at-risk stage for dementia and accurate prevalence studies are lacking in Singapore. From the literature, it is evident that psychosocial factors increase the risk of conversion to dementia. In this study, we sought to establish the prevalence of MCI in Singapore and study the associated psychosocial factors using latent profile analysis., Method: 902 community-dwelling older adults, aged between 60 and 99 years old (Mage = 70.48 years), were recruited as part of the Community Health and Intergenerational Study (CHI). They completed neurocognitive assessments and questionnaires on depression and anxiety symptoms, quality of life, social support, satisfaction with life, and social connectivity. Petersen's criteria was used to diagnose MCI. Within the MCI sample, 166 subjects' psychosocial scores were entered into a latent profile analysis to identify profiles of psychosocial functioning., Results: The prevalence of MCI in our sample was 21.5%. They had significantly lower years of education and perceived social support and higher depressive symptoms than the normal ageing group. Three distinct profiles emerged within the MCI group corresponding to a positive (45.2%), neutral (38.5%), and negative (16.3%) pattern of psychosocial scores. These profiles did not differ significantly in terms of demographic or cognitive variables., Discussion: The three psychosocial profiles might reflect the differing implications of MCI on a person's well-being and the negative psychosocial profile might likely be most at risk of conversion to dementia. Future longitudinal studies are required to confirm these implications., Competing Interests: Conflict of Interest None of the authors have any conflicts of interest to declare., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: There is a scarcity of naturalistic follow-up studies on cognitive stimulating activities (CSAs), particularly in a real-world setting and over long-term. We thus investigated a pooled novel CSA intervention to prevent cognitive decline amongst community-dwelling older adults without dementia., Methods: Nested within a community-based longitudinal follow-up cohort study of community-dwelling and multi-ethnic older adults (N = 991), a subset of the cohort (n = 264) underwent four single-blinded randomized controlled trials involving four novel CSAs, including mindfulness, horticulture, art therapy, and choral singing. At the cohort's 5-year follow-up, we examined if involvements in the CSAs improved cognition, compared to controls (n = 727). The primary outcomes were changes in global cognition and specific cognitive domain scores measured by the mini-mental state examination (MMSE). Exploratory subgroup analyses stratified by baseline cognitive status and the number of CSAs were also conducted., Results: Compared to the control group, there was a small improvement in the CSA group on the total MMSE score (d = 0.108) and MMSE-immediate recall score (d = 0.199). Furthermore, subgroup analyses revealed medium effect sizes of improvements (d = 0.420) in cognitive domains in mild cognitive impairment (MCI) (vs. cognitively healthy) and those involved in two CSAs (vs. one CSA)., Discussion: In summary, a CSA intervention improved cognition. MCI and those involved in two CSAs gained greater benefits from the CSAs. These sustained improvements in cognitive functions could have a significant impact on delaying or preventing dementia., (© 2022 John Wiley & Sons Australia, Ltd.)

Background: Physical performance declines and executive dysfunctions are predictors of dementia. However, their associations are not well understood in Asian older adults without dementia (cognitively normal [CN] and mild cognitive impairment [MCI]), especially in a single study., Objective: Examine the associations between physical performance measures with executive function (EF)-based and non-EF-based neurocognitive tests and whether preclinical dementia cognitive status i.e., CN and MCI, moderated these associations., Methods: We examined cross-sectional cohort of 716 community-dwelling older adults without dementia (CN = 562 and MCI = 154) using multivariable linear regression models. We associated three simple physical performance measures, namely timed-up-and-go (TUG), fast gait speed (FGS), and 30-s chair stand test (30 s-CST), with a comprehensive neurocognitive test battery measuring EF and non-EF cognitive functions. Moderating effects of cognitive status on the associations were examined. In all models, we controlled for pertinent covariates, including age, education, medical and psychiatric status., Results: Upon controlling for covariates, TUG was most strongly and positively associated with multiple EF-based neurocognitive tests, followed by FGS, with 30 s-CST having the weakest associations. For all physical performance measures, no significant associations with non-EF-based neurocognitive tests were detected. Cognitive status significantly moderated the associations between all physical measures and several neurocognitive tests, with stronger associations in the MCI than CN., Conclusion: Compared to FGS and 30 s-CST, TUG had the most robust associations with multiple EF-based cognitive functions. Given their differential associations with global and detailed neurocognitive tests and significant moderating effects of cognitive status, findings highlight a need to carefully consider the choices of simple physical performance tests when using these tests with a heterogenous group of community-dwelling older adults without dementia., (© 2022. The Author(s).)

Background: Olfactory impairment is aging related and is associated with cognitive decline in older adults. However, it remains unclear if an olfactory impairment is associated with mild cognitive impairment (MCI) and the degree of impairment in the MCI subtypes., Materials and Methods: In a cohort of community-living older adults aged 60 years and above, 670 participants were recruited from the Community Health and Intergenerational (CHI) Study. Olfactory function was assessed using a locally developed nine-item smell test in association with neurocognitive assessments. Analysis of covariance (ANCOVA) was used to examine the association of smell identification score and clinical cognitive status while considering demographic, clinical, and neuropsychological factors with Bonferroni correction for group comparisons., Results: Age-related smell detection between normal aging (NA) and MCI participants had no significant difference. The overall mean smell identification score in older adults was negatively correlated with age. The mean smell identification score of MCI participants was also not significantly different as compared with NA, but an amnestic MCI multiple domain (aMCI&#95;MD) subgroup had significantly lower (impaired) mean smell identification scores compared with the NA and MCI single domain (amnestic and non-amnestic) group., Conclusion: This study demonstrated that olfactory identification impairment is a comorbidity in older adults with amnestic MCI (aMCI) and is a potential marker associated with an early stage of a neurocognitive disorder. The smell test could act as a screening tool to help in the early detection of smell impairment for heterogeneous syndromes of MCI among community-dwelling older adults. Clinicians and researchers could benefit from utilizing the locally developed smell test to screen their patients or research participants before the initiation of an appropriate health intervention or in a clinical trial., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yap, Mahendran, Kua, Zhou and Wang.)

Telomere shortening is theorized to accelerate biological aging, however, this has not been tested in the brain and cognitive contexts. We used machine learning age-prediction models to determine brain/cognitive age and quantified the degree of accelerated aging as the discrepancy between brain and/or cognitive and chronological ages (i.e., age gap). We hypothesized these age gaps are associated with telomere length (TL). Using healthy participants from the ADNI-3 cohort (N = 196, Age mean =70.7), we trained age-prediction models using 4 modalities of brain features and cognitive scores, as well as a 'stacked' model combining all brain modalities. Then, these 6 age-prediction models were applied to an independent sample diagnosed with mild cognitive impairment (N = 91, Age mean =71.3) to determine, for each subject, the model-specific predicted age and age gap. TL was most strongly associated with age gaps from the resting-state functional connectivity model after controlling for confounding variables. Overall, telomere shortening was significantly related to older brain but not cognitive age gaps. In particular, functional relative to structural brain-age gaps, were more strongly implicated in telomere shortening., (Copyright © 2022. Published by Elsevier Inc.)

Purpose of Review: To provide an update on insights into the effectiveness of the green environment and forest on the mental health of city dwellers; and the role of mental health professionals in advocating green restorative therapies., Recent Findings: The studies reviewed in this paper confirmed the mental health benefits on individuals who engaged in the green environment and forest. Results of studies showed that the participants reported significantly higher positive effects. However, it is difficult to compare studies because of marked differences in methodology and often lack of biological markers. With the recent global concern about climate warming, mental health professionals have a critical role to influence city planners on the importance of the green environment and the forest. In Singapore, the 'Therapeutic Garden' project and 'Therapeutic Rainforest' program are examples of mental health professionals working with government agencies for a 'city in nature'., Summary: The benefits of the green environment and forest are emphasized especially on the psychological well being. In the light of the danger of climate warming, this review highlights the need for city planners to collaborate with mental health professionals to incorporate high-quality green spaces when planning the city of the future. There is an urgent need for better consultation between health agencies and local city government to create an appealing and diverse green environment within the city., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Few randomized controlled trials (RCTs) investigated the effects of mindfulness intervention on affective and cognitive symptoms in older adults with mild cognitive impairment (MCI). Furthermore, no RCTs on mindfulness followed participants beyond two years., Objective: To examine the longitudinal effects of a mindful awareness practice (MAP) intervention on depressive, anxiety, and cognitive symptoms in MCI., Methods: In this parallel-arm and assessor-blinded RCT, 55 community-dwelling older adults with MCI were randomized into the MAP or active control, i.e., health education program (HEP). Intervention sessions were conducted weekly for three months and monthly for the subsequent six months. Assessments and follow-up were conducted at baseline, 3-month, 9-month, and 5-year time points. Depressive, anxiety, and cognitive symptoms were measured using the Geriatric Depression Scale-15 (GDS-15), Geriatric Anxiety Inventory-20 (GAI-20), and Mini-Mental State Examination (MMSE), respectively. Linear-mixed models, following the intention-to-treat principle, were used for data analyses., Results: A total of 55 participants aged 60 to 86 (Mean age: 71.3±6 years old) was recruited, with n = 28 allocated to the MAP arm and n = 27 allocated to the HEP arm. Compared to HEP, GDS-15, GAI-20, and MMSE scores did not differ significantly in MAP during follow-ups., Conclusion: Compared to HEP, MAP did not improve affective symptoms nor delay deteriorations in general cognition in community-dwelling older adults with MCI. Compared to our previous findings showing domain-specific improvements in MAP over HEP in attention and memory up to 9 months, this study highlights the importance of examining domain-specificity using detailed cognitive measures in non-pharmacological intervention with MCI.

Background: The COVID-19 pandemic has changed our daily lives. Most of the working adults adopted the work-from-home arrangement while students shifted to home-based learning. Being confined together allows families to foster stronger bonds. On the other hand, the on-going pandemic could have negative impacts on family relationships. The COVID-19 outbreak is still on-going worldwide, understanding more about the changes in family functioning and its associated psychological impacts in a pandemic would allow the authorities to provide more targeted support to families., Objectives: This study aimed to examine the factors associated with family functioning among young adults in Singapore during the COVID-19 pandemic. Family functioning refers to the quality of interactions among family members, and consists of cohesion, flexibility and communication., Methods: A cross-sectional online survey was conducted (N = 390). The Family Adaptability and Cohesion Evaluation Scale Short Form (FACES-IV-SF) and Global Perceptions of Intergenerational Communication Scale (GPIC) were used to examine family functioning and intergeneration communication during the partial lockdown. Center for Epidemiologic Studies Depression Scale (CESD), Social Support Questionnaire-Brief (SSQ-B), Perceived Stress Scale 4 (PSS), UCLA Loneliness Scale, and Brief Resilient Coping Scale (BRCS) examined the psychosocial impact. Descriptive statistics, Pearson's correlation coefficients, and regression model were employed in the analysis., Results: The FACES-IV-SF score for total circumplex ratio has a mean of 1.57(SD = 0.58), suggesting that participants generally perceived their families as functioning relatively well. The mean scores for CESD, PSS, Loneliness and BRCS were 12.4(6.2), 8.0(2.6), 5.7(1.9) and 12.6(3.1) respectively. The mean scores of the 4 domains of GPIC were 21.5(4.0) for Accommodation, 25.0(6.7) for Non-Accommodation, 17.2(3.3) for Respect-Obligation, and 18.9(4.8) for Avoidant., Conclusion: The results suggested that family functioning is significantly associated with intergenerational communication and satisfaction with social support in a pandemic. Participants with balanced levels of cohesion and flexibility in their families are more likely to be able to cope with the psychological impacts of the pandemic. The findings serve to inform intervention and preventive efforts to improve family functioning and reduce the risk of psychological distress in a pandemic., (© 2021. The Author(s).)

The prevalence of dementia has been widely reported, and its potential risk and protective factors are well-characterized. However, there is a scarcity of related information regarding mild cognitive impairment (MCI). Thus this population-based study aimed to determine the prevalences of MCI and its subtypes, as well as to identify the risk and protective factors for MCI in the Chinese elderly population of Singapore. Results showed that the overall prevalence of MCI was 12.5%, while the gender-adjusted prevalence of MCI was 12.3%. Gender was found to be significantly associated with the subtypes of MCI, with males more likely to have amnestic MCI and females more likely to have non-amnestic MCI. Older age, lower educational levels, lower social activity levels, depression, hypertension, hyperlipidemia, diabetes and stroke were found to be risk factors for MCI in univariate analysis. However, multivariable analysis showed that only hypertension and stroke were the significant risk factors for MCI. Higher educational levels and active social engagements were significant protective factors for MCI in multivariable analysis. Age and depression had boundary significant associations with the prevalence of MCI. After adjusting for gender, the influence of hypertension, stroke, social engagement, age and depression on MCI remained unchanged, except that education became a boundary significant lower risk factor of MCI development. In conclusion, this study presented the prevalence, risk and protective factors for MCI among Singaporean Chinese older adults, which facilitates the screening of vulnerable groups for MCI., (Copyright © 2021. Published by Elsevier Ltd.)

Background: Previous meta-analyses examining the continuum of Alzheimer's disease (AD) concluded significantly decreased peripheral brain-derived neurotrophic factor (BDNF) in AD. However, across different meta-analyses, there remain inconsistent findings on peripheral BDNF levels in individuals with mild cognitive impairment (MCI). This issue has been attributed to the highly heterogenous clinical and laboratory factors. Thus, BDNF's level, discriminative accuracy for identifying all-cause MCI and its subtypes, and its associations with other biomarkers and neurocognitive domains, remain largely unknown., Methods: To address this heterogeneity, we compared a healthy control cohort (n=56, 45 female) to an MCI cohort (n=40, 28 female), to determine whether plasma BDNF, hs-CRP, and DHEA-S can differentiate healthy from MCI individuals, including two MCI subtypes (amnestic [aMCI] and non-amnestic [non-aMCI]). The associations between BDNF with other biomarkers and neurocognitive tests were examined. Adults with cerebral palsy were included as sensitivity analyses., Results: Compared to healthy controls, BDNF was significantly higher in all-cause MCI, aMCI, and non-aMCI. Furthermore, BDNF had good (AUC=0.84, 95% CI=0.74 to 0.95, p<0.001) and excellent discriminative accuracies (AUC=0.92, 95% CI=0.84 to 1.00, p<0.001) for all-cause MCI and non-amnestic MCI, respectively. BDNF was significantly and positively associated with plasma hs-CRP (β=0.26, 95% CI=0.02 to 0.50, p=0.038), despite attenuated association upon controlling for BMI (β=0.15, 95% CI=-0.08 to 0.38, p=0.186). Multiple inverse associations between BDNF and detailed neurocognitive tests were also detected., Conclusions: These findings suggest BDNF is increased as a compensatory mechanism in preclinical dementia, supporting the neurotrophic and partially the inflammatory hypotheses of cognitive impairment.

Background: With an aging population, developing non-pharmacological interventions (NPIs) to delay dementia has become critical. Apart from cognitive decline, dementia is associated with multiple pathophysiology, including increased oxidative stress, dysregulated gene expressions, cytokine, neurotrophin, and stress markers, telomere shortening, and deteriorations in brain connectivity. Although mindfulness practices have been proposed to ameliorate these biological changes, no empirical studies were conducted. We thus aimed to investigate the effects of mindfulness awareness practice (MAP) to prevent cognitive decline and improve peripheral biomarkers in community-dwelling older adults diagnosed with mild cognitive impairment (MCI)., Methods/design: This was a single-blinded and parallel-group randomized controlled trial with two arms (intervention and active control arms), conducted over nine months. A total of 60 consenting community-dwelling older adults diagnosed with MCI were planned to be randomized in a 1:1 ratio to either the MAP or the Health Education Program (HEP). Interventions were performed weekly for the initial 12 weeks, and monthly for the subsequent six months. Outcome measures were assessed at baseline, 3-month, and 9-month post-intervention by blinded assessors. Primary outcomes were neurocognitive tests, comprehensive peripheral biomarkers, and brain imaging scans. Secondary outcomes included basic health screening measures, affective symptoms, and measures of physical functions. Linear-mixed models were used to examine the effects of MAP on these outcome measures., Significance: This is the first randomized controlled trial to systematically investigate the effects of a mindfulness intervention in improving cognitive functions and various biomarkers in community-dwelling older adults diagnosed with MCI. Our findings have the potential to inform mindfulness intervention as a novel approach to delay dementia.

In Singapore, many older adults suffer from subsyndromal depression and/or subsyndromal anxiety, which can negatively impact their physical and mental well-being if left untreated. Due to the general public's reluctance to seek psychological help and the low psychiatrist-to-population ratio in Singapore, this study aims to examine the preliminary efficacy, perceptions, and acceptability of a trained volunteer-led community-based intervention on community-dwelling older adults. Twenty-one participants (control: n = 11; intervention: n = 10) completed the randomized pilot study. A mixed-methods approach (questionnaires, semistructured interviews, examining blood samples, intervention fidelity) was adopted. No significant differences were found between the intervention and the control groups in depression, anxiety, life satisfaction, friendship, and quality of life. However, there was a positive change in quality-of-life scores from baseline to 6 months in the intervention group. The control group had significantly higher cortisol levels and lower annexin-A1 levels at 6 months, while the intervention group did not. Three themes emerged from the interviews: (1) impact of the intervention on older adults' well-being, (2) attitudes toward intervention, and (3) a way forward. However, intervention efficacy could not be established due to small sample size caused by the coronavirus pandemic. Future randomized controlled trials should evaluate volunteer-led, technology-based psychosocial interventions to support these older adults.

Background: Elevated levels of inflammatory marker and a lack of social connectedness are two prominent risk factors for developing dementia and depression. Horticultural therapy (HT) has been shown to improve social connectedness and inflammatory markers. However, the underpinning mechanisms of HT remained unknown. Within this study, we hypothesized that improved social connectedness mediates the effects of HT on IL-6 levels., Methods: The present study is a secondary analysis of a randomized controlled trial investigating the bio-psycho-social effects of HT. Social connectedness was operationalized as positive relationships with others (PRWO), a sub-scale of the Ryff's scale of psychological well-being. IL-6 was quantified using a commercial ELISA kit. Outcomes were assessed at baseline, 3-month and 6-month post-intervention. Mediation analyses with bootstrapping were run to investigate our primary hypothesis. All analyses were controlled for covariates., Results: We recruited 59 participants (78% women; 67.10 ± 4.31 years). 29 participants partook in HT and 30 participants were included in the waitlist control group. At baseline, social connectedness was significantly correlated with IL-6 levels (β = -0.12, 95% CI = -0.21 to -0.03, p = 0.008). Furthermore, social connectedness at 3-month significantly mediated the effects of HT on IL-6 levels at 6-month (β = 0.32, 95% CI = 0.09 to 0.54, p = 0.005; β = -0.25, 95% CI = -0.45 to -0.05, p = 0.016)., Conclusions: These findings highlight the critical roles of social connectedness as a social determinant of health in eliciting HT's biological effects. When administering HT, interventionalists should consider social connectedness as a modifiable factor for ameliorating increased inflammation in older adults., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objectives: As the global burden of dementia rises, the search for preventive measures such as interventions for mild cognitive impairment (MCI) remains a research priority. While arts-based interventions have demonstrated some success in improving cognitive functioning among older adults and those with dementia, its effectiveness for older persons with MCI remains unexplored. We conducted a systematic review to examine the effects of arts-based interventions on cognition in older persons with MCI., Method: The following databases were searched in November 2019: PubMed, EMBASE, PsycINFO, and CINAHL Plus, supplemented by Google Scholar and ALOIS. Study inclusion criteria were older persons aged ≥ 60 with MCI; arts-based interventions such as dance, drama, music, or visual arts; and randomized controlled trial with cognitive outcome. Database search, study selection, and data extraction were conducted independently by 2 reviewers., Results: Eleven randomized controlled trials examining 13 interventions (817 participants) were identified, of which 4 involved visual arts, 4 dance/movement, 3 music, and 2 storytelling. Significant improvement on at least one cognitive outcome was reported in 10 of the 13 interventions. These included improvements in global cognition (6/7 interventions), learning and memory (5/9), complex attention (4/10), executive functioning (2/6), language (2/3), and perceptual-motor function (1/4)., Conclusion: This review found that arts-based interventions can potentially improve various aspects of cognitive functioning in older persons with MCI, although our confidence was dampened by methodological limitations such as the moderate-to-high risk of bias present in studies and heterogeneity in the way MCI was defined. Recommendations for future research are discussed.

Geriatric depression and anxiety disorders often manifest as neuropsychiatric symptoms among those with mild cognitive impairment. Both tend to co-occur, and overlap in symptomology and etiology. Such commonalities are likely to be reflected in the brain as common neural correlates. Using connectome-based predictive modeling (CPM), we examined the functional and structural connectomes predicting depression and anxiety symptoms, and subsequently the overlap and cross-syndrome generalization of the connectomes associated with either disorder. Ninety-one older adults completed self-reported measures of depression and anxiety, and underwent diffusion tensor imaging and resting-state functional magnetic resonance imaging. Functional connectivity (FC) and structural connectivity (SC) matrices were derived from these scans and, in various combinations, entered into CPM models to predict either type of symptoms. Leave-one-out cross-validation was performed. Predictive accuracy was assessed via the correlation between predicted and observed scores (ρ predicted-observed ). While FC or SC features alone significantly predicted either type of symptoms, these symptoms were best predicted by models that consisted of both FC and SC features (depression: ρ predicted-observed  = 0.497; anxiety: ρ predicted-observed  = 0.455). The features common to depression and anxiety were identified and entered into another model which was similarly accurate in predicting either type of symptoms. Moreover, cross-syndrome generalization was observed- the depression-associated features significantly predicted anxiety symptoms (ρ predicted-observed  = 0.403) and vice-versa (ρ predicted-observed  = 0.378). These FC and SC features are complementary biomarkers of geriatric depression and anxiety symptoms. Both types of symptoms are largely underpinned by common patterns of altered FC and SC, alluding to the transdiagnostic neurobiological susceptibility in both disorders., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Dietary counselling has been identified as one of the nutritional strategies to alleviate cardiometabolic health conditions. Its effectiveness however may vary due to factors such as intensity level and provider while this has not been comprehensively studied. This systematic review and meta-analysis aimed to assess the effects of dietary counselling on the cardiometabolic health in middle-aged and older adults and the sub-group analyses with dietary counselling intensity and the provider were also assessed. Four databases including PubMed, CINAHL Plus with Full Text, Cochrane Library and EMBASE were systematically searched. Data from 22 randomised controlled trials (RCTs) were compiled and those from 9 RCTs were utilised for meta-analysis. Dietary counselling lowered total cholesterol (TC) and fasting blood sugar (FBS) but had no impact on triglycerides (TG) and low-density lipoprotein (LDL). Sub-group analysis revealed significant lowering effect of high intensity dietary counselling for TG (weighted mean difference (WMD): -0.24 mmol/L, 95% confidence intervals (CIs): -0.40 to -0.09), TC (WMD: -0.31 mmol/L, 95% CIs: -0.49 to -0.13), LDL (WMD: -0.39 mmol/L, 95% CIs: -0.61 to -0.16) and FBS (WMD: -0.69 mmol/L, 95% CIs: -0.99 to -0.40) while medium or low intensity dietary counselling did not show favouring effects. Counselling provider showed differential responses on cardiometabolic health between dietitian and all other groups. The findings from this systematic review and meta-analysis suggest that dietary counselling is a beneficial dietary strategy to improve cardiometabolic health in middle-aged and older adults with the emphasis on the counselling intensity.

Introduction: Perceptions of the educational environment (EE) represent an important source of information on medical students' learning experience. Understanding and addressing these perceptions can help inform initiatives designed to improve the learning experience and educational outcomes, while comparison of student perceptions across medical schools can provide an added perspective. The aim of the study was to compare the EEs of three Asian medical schools: Royal College of Surgeons in Ireland and University College Dublin Malaysia Campus, Yong Loo Lin School of Medicine, Singapore and Xiangya School of Medicine, China., Methods: Medical students in the clinical years (N = 1063) participated in a cross-sectional study using the Dundee Ready Educational Environment Measure (DREEM). Data were analyzed using SPSS version 22., Results: There were significant differences between the three medical schools in the total DREEM scores (F [2, 1059] = 38.29, p < .001), but all were in the category "more positive than negative" (mean score 135.42, range 128.97-142.44). Highest DREEM scores were noted in year 5 at RUMC (139.79 ± 79), year 3 at YLL (145.93 ± 14.52), and year 4 at XSM (138.56 ± 18.91). Variations in total and subscale DREEM scores were also found between clinical years in each medical school., Discussion: Total DREEM scores at the three medical schools are similar to those reported from other undergraduate settings. However, significant variations occurred in perceptions of the EE, as students progressed through the clinical years. Greater attention to the learning environment and the curriculum may improve students' educational experience., (© 2021 John Wiley & Sons Australia, Ltd.)

Background: Few randomized controlled trials have investigated the effects of mindfulness intervention on older adults diagnosed with mild cognitive impairment (MCI). Specifically, scarce literature exists on the potential benefits of mindfulness intervention on biomarkers representing AD hallmarks. Our previous studies showed the potential of Mindful Awareness Practice (MAP) in improving multiple biomarkers of gut microbiota, systemic inflammation, and synaptic functions. Extending these findings, in this study, we conducted analysis on bio-banked saliva samples, examining whether MAP improved salivary amyloid beta-42 (Aβ-42) levels in community-dwelling older adults diagnosed with MCI. We also explored the moderating role of education level, an indicator of cognitive reserve, on intervention effect., Methods: A total of 55 community-dwelling older adults diagnosed with MCI were randomized into either the treatment arm, MAP, or the active control arm, the health education program (HEP). Interventions were performed for a total of nine months. Field and laboratory investigators who were blinded to the treatment allocations collected saliva samples at baseline, 3-month, and 9-month follow-ups. Salivary Aβ-42 levels were quantified using a commercial assay. Linear-mixed models were used to examine the effect of MAP on salivary Aβ-42 levels., Results: Compared to the HEP arm, MAP participants had no significantly modified Aβ-42 levels throughout the 9-month intervention period, regardless of subgroup analyses stratified by either sex or MCI-subtypes (amnestic and non-amnestic). Exploring the moderating effect of education, participants in the HEP arm with higher education levels had significantly lower salivary Aβ-42 at 3-month time-point., Discussion: Taken together with our previous findings and other mindfulness interventional studies failing to find a significant effect on peripheral Aβ-42, we conclude the non-significant effects of mindfulness intervention on ameliorating peripheral Aβ-42 levels. Conversely, participants in the HEP arm with higher cognitive reserve had significantly improved salivary Aβ-42, highlighting the role of cognitive reserve in moderating treatment response in MCI., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Mindfulness-based interventions can enhance cognitive abilities among older adults, thereby effectively delaying cognitive decline. These cognitive enhancements are theorized to accompany neuroplastic changes in the brain. However, this mindfulness-associated neuroplasticity has yet to be documented adequately. A randomized controlled trial was carried out among participants with mild cognitive impairment (MCI) to examine the effects of a mindfulness-based intervention on various cognitive outcomes and cortical thickness (CT) in the context of age-related cognitive impairment. Participants were assigned to a mindfulness awareness program (MAP)(n = 27) and an active control condition - health education program (n = 27). In both, they attended weekly sessions for three months and subsequently, monthly sessions for six months. Cognitive assessments and structural scans were carried out across three time-points. Whole brain analyses on CT were carried out and were supplemented with region of interest-based analyses. ROI values and cognitive outcomes were analyzed with mixed MANOVAs and followed up with univariate ANOVAs. Nine-month MAP-associated gains in working memory span and divided attention, along with an increased CT in the right frontal pole and decreased CT in the left anterior cingulate were observed. Three-month MAP-associated CT increase was observed in the left inferior temporal gyrus but did not sustain thereafter. MAP led to significant cognitive gains and various CT changes. Most of these neurobehavioral changes, may require sustained effort across nine months, albeit at a reduced intensity. MAP can remediate certain cognitive impairments and engender neuroplastic effects even among those with MCI., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Aging is one of the most important public health issues. The World Health Organization (WHO) expects the number of older adults aged 65 and above to triple from 2010 to 2050. A major challenge would be to consider how functional ability and quality of life could be enhanced in older age. Reminiscence-based interventions are widely reported as having positive effects on psychological outcomes among older adults with dementia, but its effects on cognitively intact older adults have not been clearly evaluated., Objectives: The aim of the current systematic review is to evaluate the existing evidence on the effects of reminiscence-based intervention on psychological outcomes in cognitively intact older adults., Review Methods: Commonly used English databases, including CINAHL, EMBASE, MEDLINE and PsycINFO, were searched from inception till 31 Mar 2020. Studies were included if they examined the effects of reminiscence-based intervention on psychological outcomes among cognitively intact older adults aged 60 and above. Meta-analysis was conducted to synthesise the effects on different psychological outcomes., Results: Thirty-one studies involving 1,829 older adults were included. The pooled standardized mean difference for depressive symptoms and life satisfaction were -0.38 (95% CI: -0.69--0.07) and 0.33 (95% CI: 0.14-0.52) respectively. Positive effects were observed on self-esteem, psychological well-being and happiness, though meta-analysis could not be conducted., Conclusion: Significant reduction of depressive symptoms and improvement of life satisfaction were revealed from the reminiscence-based intervention among cognitively intact older adults. In addition, reminiscence-based intervention has been effective in enhancing self-esteem, and promoting psychological well-being and happiness. Our results suggest that reminiscence-based intervention could be an effective solution to improve psychological well-being among cognitively intact older adults. Such non-pharmacological approach can be recommended for older adults at the community level., Competing Interests: Conflict of Interest Nil., (Copyright © 2020. Published by Elsevier Ltd.)

Clinically, individuals with cerebral palsy (CP) experience symptoms of accelerated biological aging. Accumulative deficits in both molecular underpinnings and functions in young adults with CP can lead to premature aging, such as heart disease and mild cognitive impairment (MCI). MCI is an intermediate stage between healthy aging and dementia that normally develops at old age. Owing to their intriguingly parallel yet "inverted" disease trajectories, CP might share similar pathology and phenotypes with MCI, conferring increased risk for developing dementia at a much younger age. Thus, we examined this hypothesis by evaluating these two distinct populations (MCI= 55, CP = 72). A total of nine measures (e.g., blood biomarkers, neurocognition, Framingham Heart Study Score (FHSS) were compared between the groups. Compared to MCI, upon controlling for covariates, delta FHSS, brain-derived neurotrophic factor (BDNF) levels, and systolic blood pressure were significantly lower in CP. Intriguingly, high-sensitivity CRP, several metabolic outcomes, and neurocognitive function were similar between the two groups. This study supports a shared biological underpinning and key phenotypes between CP and MCI. Thus, we proposed a double-hit model for the development of premature aging outcomes in CP through shared biomarkers. Future longitudinal follow-up studies are warranted to examine accelerated biological aging.

Background: With the challenges that aging populations pose to health care, interventions that facilitate alleviation of age-related morbidities are imperative. A prominent risk factor for developing age-related morbidities is immunosenescence, characterized by increased chronic low-grade inflammation, resulting in T-cell exhaustion and senescence. Contact with nature and associated physical activities have been shown to boost immunity in older adults and may be promoted in the form of horticultural therapy (HT). We aimed to examine the effects of HT on immunosenescence., Method: We conducted a randomized controlled trial with 59 older adults assigned to either the HT intervention or waitlist control group. Older adults in the HT intervention group underwent HT intervention program over 6 months. Venous blood was drawn at baseline and at the third and sixth month from the commencement of this study. For participants who attended all 3 blood collection time points (HT: n = 22; waitlist: n = 24), flow cytometry analysis was performed on whole blood samples to evaluate the kinetics of lymphocyte subsets over the intervention period, revealing the composition of CD4+ and CD8+ subsets expressing exhaustion markers-CD57, CTLA4, and KLRG1. Enzyme-linked immunosorbent assays were employed to measure changes in plasma IL-6 levels., Results: HT is associated with increased numbers of naive CD8+ T cells and fewer CTLA4-expressing terminally differentiated effector CD4+ and CD8+ memory T cells re-expressing CD45RA (TEMRA). Furthermore, IL-6 levels were reduced during HT, and the frequencies of naive and TEMRA CD8+ T cells were found to be associated with IL-6 levels., Conclusion: HT is associated with a reduction in the levels of biomarkers that measure the extent of T-cell exhaustion and inflammaging in older adults. The positive effects of HT on T-cell exhaustion were associated with the reduction of IL-6 levels., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Objective: Previous research on art therapy (AT) in cognitive aging has been lacking. AT can potentially engender significant cognitive gains, due to its rigorous cognitive involvement, making it useful to tackle age-related cognitive decline. Along with these cognitive gains, associated neuroplastic changes are hypothesized to arise from AT as well. The current intervention examined the effects of an AT intervention on cognitive outcomes and cortical thickness (CT) among participants with mild cognitive impairment., Method: Participants were assigned to AT (n = 22) and an active control group (n = 27). In both, weekly 45-min sessions were carried out across 3 months. Cognitive assessments and structural magnetic resonance imaging scans were carried out at baseline and 3-month follow-up. Whole brain analyses on CT were carried out. Cognitive outcomes were analyzed using hierarchical linear models., Results: Significant gains in immediate memory and working memory span were observed in the AT group, relative to the control group. Significantly increased CT in the AT group, relative to controls, was observed in a right middle frontal gyrus (MFG) cluster. Furthermore, CT changes in this cluster were significantly and positively correlated with changes in immediate memory., Conclusion: These findings highlighted the role of MFG neuroplasticity in enhancing certain cognitive functions in AT. AT is a neuroplastic intervention capable of engendering significant cognitive gains and associated cortical changes in the context of age-related cognitive decline, even when executed as a low-intensity intervention across 3 months. Given the preliminary nature of these findings, future larger sampled studies are needed.

We conducted a randomized controlled trial to examine choral singing's effect on cognitive decline in aging. Older Singaporeans who were at high risk of future dementia were recruited: 47 were assigned to choral singing intervention (CSI) and 46 were assigned to health education program (HEP). Participants attended weekly one-hour choral singing or weekly one-hour health education for two years. Change in cognitive function was measured by a composite cognitive test score (CCTS) derived from raw scores of neuropsychological tests; biomarkers included brain magnetic resonance imaging, oxidative damage and immunosenescence. The average age of the participants were 70 years and 73/93 (78.5%) were female. The change of CCTS from baseline to 24 months was 0.05 among participants in the CSI group and -0.1 among participants in the HEP group. The between-group difference (0.15, p =0.042) became smaller (0.12, p =0.09) after adjusting for baseline CCTS. No between-group differences on biomarkers were observed. Our data support the role of choral singing in improving cognitive health in aging. The beneficial effect is at least comparable than that of health education in preventing cognitive decline in a community of elderly people. Biological mechanisms underlying the observed efficacy should be further studied.

There is ample scientific and clinical evidence of the effects of gut microbiota on the brain but no definitive evidence that the brain can affect changes in gut microbiota under the bi-directional gut-brain axis concept. As there is no pharmacotherapeutic intervention for the early stages of cognitive decline, research has focused on cognitive stimulation in reversing or slowing the impairment. Elderly patients diagnosed with mild cognitive impairment underwent a randomized-control trial of mindful awareness practice. Neuropsychological assessments, inflammatory markers, and gut microbiota profiles were tested. Here, we report that their cognitive impairment was improved and associated with changes in gut bacterial profile. A cognition-score-dependent-abundance was observed in Ruminococcus vs Recognition Trials (RT), Digit Span Backward (DSB), Semantic Fluency Span (SFS) and Memory Domain (MD); Coprococcus vs DSB, Color Trails Test 2 (CTT2) and Block Design (BD); Parabacteroides vs DSB and SFS; Fusobacterium vs DSB and CTT2; Enterobacteriaceae vs BD and SFS; Ruminococcaceae vs DSB; Phascolarctobacterium vs MD. The study showed for the first-time, alteration in the cognitive capacity leading to the corresponding changes in microbiota profiles. This strongly suggests that signals from the different segments of brain could dictate directly or indirectly the abundances of specific gut microbes.

Neuropsychological assessments are essential in diagnosing age-related neurocognitive disorders. However, they are lengthy in duration and can be unreliable at times. To this end, we explored a modified connectome-based predictive modeling approach to estimating individualized scores from multiple cognitive domains using structural connectivity (SC) and functional connectivity (FC) features. Multi-shell HARDI and resting-state functional magnetic resonance imaging scans, and scores from 10 cognitive measures were acquired from 91 older adults with mild cognitive impairment. SC and FC matrices were derived from these scans and, in various combinations, entered into models along with demographic covariates to predict cognitive scores. Leave-one-out cross-validation was performed. Predictive accuracy was assessed via the correlation between predicted and observed scores (r predicted-observed ). Across all cognitive measures, significant r predicted-observed (0.402 to 0.654) were observed from the best-predicting models. Six of these models consisted of multimodal features. For three cognitive measures, their best-predicting models' r predicted-observed were similar to that of a model that included only demographic covariates- suggesting that SC and/or FC features did not contribute significantly on top of demographics. Cross-prediction models revealed that the best-predicting models were similarly accurate in predicting scores of related cognitive measures- suggesting their limited specificity in predicting cognitive scores. Generally, multimodal connectomes together with demographics, can be exploited as sensitive markers, though with limited specificity, to predict cognitive performance across a spectrum in multiple cognitive domains. In certain situations, it may not be worthwhile to acquire neuroimaging data, considering that demographics alone can be similarly accurate in predicting cognitive scores., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2020. Published by Elsevier Inc.)